This evidence review focuses on the stigma associated with mental health, why tackling it is so important and why it is fundamental to developing cost effective child and adolescent mental health services (CAMHS). stigma associated with mental health problems is pervasive, and its influence is transmitted through various routes. It is ingrained within our language, our culture, and for many young people it is a social norm.
The stigma associated with having a mental health problem can have a more profound impact than the mental health problem itself. The surgeon General of the united states stated that stigma is the most important problem facing the entire mental health field (Hinshaw 2005).
So, understanding what stigma is, how it is transmitted and how to reduce its impact is crucial to encouraging children, young people and their families to seek support to talk openly about their emotions and help if they have concerns about their mental health.
Young people from our Very Important Kids (VIK) participation project have told us how important tackling stigma is to them (YoungMinds Children and Young People’s Manifesto 2010). As a result we have prioritised stigma as one of our key campaign areas. This Evidence review will look at what stigma is and why people stigmatise from various different perspectives; people’s attitudes to mental health; how it impacts on young people’s mental health, and how it can be tackled.
The first part of this review looks at definitions of stigma. Stigma literally means being marked or branded, but it refers to a group of people, in this instance, young people with mental health problems, being categorised as being different from the social norm, and being shunned and devalued as a result.
Stigma is an overarching term which consists of three elements:
• The problem of knowledge - Ignorance
• The problem of attitudes - Prejudice
• The problem of behaviour - Discrimination
Stigma has a profound effect on a number of different levels:
• Public stigma – where large social groups endorse stereotypes about mental illness
• Self-stigma – where people internalise public stigma, which results in a loss of self-esteem and self-efficacy.
• Label avoidance – where people don’t seek help to avoid being labelled with a stigmatising mental health problem
Experience and perspectives of stigma
The evidence review then goes on to look at how people experience stigma. stigma has been shown to have a profound effect on a person’s sense of self, and diminish their self-esteem and confidence. It can also prevent people with mental health problems from seeking help. There is more stigma associated with mental health problems compared to other health problems (Gale, 2006). Children and young people have been shown to experience higher levels of stigma than adults (Rose et al., 2007). Stigma is pervasive and not only affects the individual with the mental health problem, but it also impacts on their family.
Stigma has been studied from a number of different theoretical perspectives. The focus of some studies being on the individual, whereas others focus on wider community or societal issues. The review considers these different perspectives and examines how they contribute to our understanding of stigma.